WASHINGTON – The comment period ended on June 6 for the Centers for Medicare and Medicaid Services' (CMS) proposed rule on accountable care organizations (ACOs).
ACOs, composed of doctors, hospitals, labs and other care providers bonding together to improve care while reducing costs, have been touted by CMS to be among the cornerstones of healthcare payment innovation in the 21st century.
The ACO proposed rule, issued March 31, has drawn a great deal of opposing and controversial opinions from stakeholders.
“The concept of the ACO, with provider accountability for cost containment and quality improvement, represents a real effort towards building a new value-driven healthcare system to address the critical shortcomings in the current payment model,” said Leigh Burchell, vice president of government affairs and public policy for Allscripts and chair of the EHR Association's Public Policy Leadership Work Group.
“Ultimately," she added, "we need to improve care coordination for individuals, improve population health, and lower the growth in healthcare-related expenditures. ACOs, if established properly, can be an important tool in accomplishing these objectives.”
The Campaign for Better Care (CBC), a broad-based coalition of consumer organizations, said the proposed rule is moving in the right direction.
"The ACO proposed rule is premised on patient-centered care, patient engagement, a strong foundation of primary care, performance measurement including patient experience, and meaningful stakeholder involvement. These elements are the key to a successful ACO and genuine transformation of our care delivery system overall," the group said.
CBC emphasized that the federal government can't afford to set the bar too low, when it comes to ACOs.
The American Hospital Association (AHA) recently released a study that found the cost of start-up and an initial year of management for an ACO will run between $11.6 million to $26.1 million – much higher than the $1.8 million estimated by CMS.
“CMS’s estimate falls short of the mark,” said Rich Umbdenstock, president and CEO of the AHA. “The shared savings rate with ACOs should be adjusted to reflect these costs in order to encourage and enable participation in this important program.”
CMS launched in June a Pioneer ACO model estimated to save Medicare as much as $430 million over three years by better managing care for beneficiaries and eliminating duplication. The program is designed to work in tandem with private payers. Some of the savings will be passed on to ACOS, with Pioneer ACOs sharing in the savings at a more advanced rate.
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